News (Updated February 5,
2006)
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By Evan Osnos
Tribune foreign correspondent
Published February 5, 2006
RUILI, China -- This ancient road has had many names: Old
tea-horse trail. The Burma Road. Route 320. But the label that matters most
today is one that appears on no sign at all: the AIDS road.
Past truck-stop brothels and through disease-ravaged cities and villages in
China's far southwest Yunnan province, this two-lane road carves the path of
an HIV epidemic that is growing faster than international health officials
previously thought.
This is the main road through the epicenter of AIDS in the world's most
populous country, where a new national study shows that 200 people are being
infected every day. It is a central artery through which sex, drugs and trade
are spreading the virus into previously untouched swaths of the population,
researchers say.
There are ominous precedents. Key trucking routes like this helped spread AIDS
to tens of millions of people in India and Africa, the world's worst-hit
regions, starting with drug users and prostitutes, then truck drivers and,
ultimately, their families. As China's surging economy fuels the construction
of thousands of miles of new roads, health officials, activists and frontline
doctors are racing to curb the Chinese epidemic before a similar explosion
occurs.
"Most Chinese people still think that only drug users and sex workers are
affected," said Wang Jing, an HIV counselor in the provincial capital,
Kunming, "but . . . the disease has begun affecting everyone."
After initially denying it had an AIDS problem, China acknowledged the full
scale of the epidemic in 2003 and has made strides in embracing foreign aid,
tackling drug abuse and providing medical care, AIDS experts say.
To journey along the road to Ruili, Baoshan, Mengshi, Kunming and many stops
in between is to traverse a timeline of China's struggle with AIDS: the
origins, the present and the obstacles ahead. Life along the road also
illustrates how a shortage of government funds, the stigma surrounding the
virus and public misunderstanding of its spread into the wider population are
threatening efforts to control the epidemic.
The largest survey on AIDS in China, released Jan. 25, showed that the rate of
infection is rising, with 70,000 new cases reported last year. More important,
the joint study by China, the World Health Organization and the United
Nations' AIDS program found that the disease is moving into the general
population, with a growing share of infection in pregnant women and the
spouses of men who visit prostitutes.
"Sex work is moving it toward the general population," said Henk
Bekedam, the China representative for WHO. The new infection rate, he said,
showed the situation in China was "more serious than we thought."
Ground zero of China's AIDS epidemic is this remote border town, where Route
320 begins its 500-mile journey north to Kunming as an inconspicuous ribbon of
dirt veering over the boundary from Myanmar.
Pivotal city for centuries
Ruili has a reputation as China's gateway to Southeast Asia, where explorers,
armies and criminals have gravitated for centuries to swap jade, arms and
poppies. Some of China's earliest AIDS cases were found here in 1989, and by
the mid-90s the mix of Chinese and Burmese heroin addicts and prostitutes
accounted for more HIV cases than any other city in the country. When the
government vowed to strike hard against prostitution, police simply closed the
karaoke bars and "hair salons," sending sex workers into even darker
corners of society.
But Ruili now illustrates China's efforts to stem the epidemic. The government
has opened 10 methadone clinics to help wean addicts from heroin, and
foreign-aid groups are permitted to promote testing and condom use among
prostitutes.
That new approach is on display at the Rainbow Center, a foreign-funded
non-governmental organization in Kunming, where former and current drug users
slip into a nondescript two-story building to spend their days together, pick
up free needles and condoms, and get tested for HIV, with the assurance that
they won't be arrested when they step outside, as they still are in much of
China.
"Many of those programs were illegal until last year," said Hu Jin
of Save the Children UK. "In the past, just holding condoms could be used
as evidence to arrest [sex workers]."
But China's challenge has moved beyond simply high-risk populations. The task
is educating a population that misperceives the virus as the exclusive scourge
of drug addicts and prostitutes. The road north through the mountains--part of
the Burma Road supply line used by U.S. and Chinese troops in World War II--is
lined with scores of hamlets such as Sugarcane Garden Village, little more
than a cluster of palm trees, small stone homes and an elementary school. The
population of 1,100 makes its living planting vegetables and rice and selling
snacks to truck drivers.
"Our No. 1 problem? Drugs," said Yang Senbin, 62, a farmer. "It
will ruin your life. We hate this problem."
Yang lives amid one of the densest concentrations of AIDS cases in China, but
asked if he has ever met a person living with the disease, he said he didn't
think so.
That's because people with HIV in China rarely dare to reveal it. In her denim
jacket and lightweight black scarf, 33-year-old Ma looks like anyone else in a
Kunming restaurant. Ma, who didn't want her full name used, contracted HIV
after 10 years of shooting heroin, which she took up as a teenager because it
seemed as though everyone else was doing it, she said.
She is hardly the image of a street addict, yet she is the face of China's
evolving HIV problem. Even though Ma works full time helping people with HIV
get access to government services, she doesn't dare tell her parents she is
sick.
"I'm afraid they will be very disappointed," Ma
said.
The recent study estimated that China has 650,000 HIV/AIDS cases, revised from
rougher estimates of 840,000. That change reflects only a better measure of
how many people were infected in a limited outbreak tied to a blood-selling
scheme. As the study's authors cautioned, "those new numbers should not
mask the fact that HIV infections are on the rise."
That rise reflects in part the rapid growth of prostitution during two decades
of economic reform, which have fueled unemployment and sent millions of
peasants migrating in search of work. Chinese authorities estimate there are 3
million to 4 million women working as prostitutes in massage parlors and truck
stops and so-called karaoke bars and hair salons.
They are places such as the Chrysanthemum Inn, a dilapidated roadside shack
just up the road from Ruili. A bare bulb illuminates the unheated dining room
and a row of rooms--each with bare walls, a bed and a pink blanket--are marked
with hand-painted white numbers: 1, 2, 3. The overloaded trucks that whine to
a stop here are headed everywhere --Beijing, Shanghai and beyond.
"Are you looking for a virgin?" the lead cook asked a table of
visitors. She could produce one, she said, for about $2,500. A local taxi
driver snorted and countered that he could find one for $125.
After lunch, the cook offered sex with a female kitchen worker for $6. But
asked what it would cost for sex without a condom, she said, "No way. Not
in this day and age. Everybody's afraid of dying."
To prevention specialists, that is very encouraging--far more encouraging than
the experience of one counselor who recently demonstrated condom use to a
group of peasants by employing a banana as a prop. When she returned weeks
later, she was greeted by puzzled villagers who pointed to the banana tree,
with the condom still affixed on a piece of fruit, and complained that its
presence had produced no benefit.
Nowhere is prostitution's role in the epidemic clearer than in Baoshan, a
low-slung mountain town of white-tile-covered buildings, where HIV spreads
mostly through sex rather than drugs, according to the local center for
disease control.
That means key players in the epidemic are people like 19-year-old Fangfang,
who spends her evenings wearing a denim miniskirt in an open-air storefront of
the red-light district, trying to entice passersby into spending about $18 to
stay a couple of hours. When she left her remote Yunnan hometown two months
ago, Fangfang was drawn by the whispered promise of far rosier prospects than
she found, she said.
"Friends had come back and told us how good the outside world is,"
she said. "But they tricked us."
Fangfang plans to go home soon. She will tell her family she worked at a
supermarket. In the meantime, she says she uses free condoms but complains
that health workers give her only three a day, so she has to make up the
shortfall with her own money. Asked whether she knows how to avoid AIDS, she
is quick to nod but later admits she is short on details.
"Can you tell me," she said, "what are the ways the disease is
transmitted?"
City health authorities estimate there are 5,000 prostitutes like her in the
Baoshan area, and they concede that, even with high-level cooperation from
party officials, they don't have the money to adequately promote condom use
among them.
"Last year the government spent half a million yuan [$62,000]" on
AIDS prevention in the area, said Yang Xuanmei, head of Baoshan's AIDS
prevention program. "That might sound like a lot of money, but we're
talking about 2.4 million people."
Condom effort uneven
As a result, prevention efforts are patchy. The government adopted a
high-profile condom distribution plan, and though condoms can be found in the
rooms of the high-end Landu Hotel, there are none at the Military District
Inn, where a stay is less than $4 a night.
Moreover, things are about to get much more complicated.
By next year, 50 miles of sleek new expressway will link Baoshan to points
south. From an AIDS standpoint, the new Baolong Highway poses multiple
threats: an influx of 10,000 mostly male workers, who later will scatter to
their home provinces, and then a fast new road to boost traffic and speed the
transfer of the virus.
The urgent task is getting the workers and drivers to use condoms, which
traditionally are unpopular in China--only 4 percent of contraceptive users
choose that method. The Asian Development Bank is sponsoring a project to
limit and measure the rise in HIV along the new highway, hoping to raise
condom use among men like road worker Zhang Mingzheng.
Zhang, 58, who was carrying rocks in the fading light of a setting sun one
recent evening, laughed when asked whether he uses condoms at local brothels.
He is too old to seek out nights like that, he said.
"But the young men, sure, in the summers they go into town," he
said. "And everyone knows the truth is people don't use condoms every
time."
An
AIDS crisis threatens the Philippines as the number of people who are HIV
carriers has doubled in just over three years, the health department warned.
A health department study projected the number of Human Immunodeficiency
Virus (HIV) carriers to have risen to 11,168, from about 6,000 in 2002,
Health Secretary Francisco Duque told reporters.
The widespread practice of unprotected sex makes AIDS a serious threat in
the Southeast Asian country, he added.
Many people who are likely living with the virus are mixing with the
general population and are unaware that they are infected, Duque said.
Men who have sex with other men, female sex workers, their male clients,
and injecting drug users are the groups most at risk, Duque said.
However, these groups account for only 2,942 of the total HIV carriers
estimated in the Philippines, said health department epidemiologist Enrique
Tayag.
"A significant change in this estimation is that 8,000 of these HIV
positives are now found in the general population. This means that current
interventions miss a hidden population that would benefit and thus avert a
major catastrophe," Duque said.
In the health department survey, one percent of injecting drug users in
Cebu, the country's number-two city, are HIV-positive, Duque said.
"For the first time after nearly a decade of surveillance, another
IDU (injecting drug user) has tested positive. This means that the
transmission among IDUs has begun and, if left unchecked, will cause the
repetition of an epidemic similar to that of Thailand," Duque warned.
World Health Organization country representative John Marc Olive said the
discovery of HIV-positive injecting drug users should serve as a "red
flag" for the Philippines taking into consideration Thailand's
experience when those infected by the virus transmitted HIV by sharing
needles.
Duque said many injecting drug users had multiple sex partners, did not
practice safe sex, and shared needles.
Duque said the government had set aside 20 million pesos (383,000
dollars) to stockpile anti-retroviral drugs for HIV/AIDS sufferers. The
virus destroys the human body's immune system.
"It's a dilemma for the (health department) to have to manage
opposition from the (Roman) Catholic Church because it views condoms also as
a family planning method and not just a tool against HIV/AIDS," Duque
said.
He urged the church to allow the government to promote condom use among
the faithful in this mainly Catholic country.
South African President Thabo Mbeki sought to defuse criticism of his
government's HIV/AIDS policy, saying more than 100,000 people were getting
free drugs in one of the world's biggest public health programs.
"The Operational Plan for Comprehensive Prevention, Treatment and
Care of HIV and AIDS has resulted in the upgrading of hundreds of
facilities," he said in his annual state of the nation address to
parliament.
"To date, over 100,000 patients are receiving anti-retroviral
treatment, and combined with patients in the private sector, South Africa
has one of the largest such treatment programs in the world."
South Africa has one of the world's biggest AIDS caseloads with around
one in seven people, or 6.5 million, living with HIV or AIDS, according to
the health ministry.
AIDS activists estimate that as many as 500,000 South Africans are in
need of the life-saving drugs.
Mbeki has been roundly criticized in the past for questioning the link
between HIV and AIDS.
Nigeria's top defence official said that HIV/AIDS was a threat to the
west African country's national security and praised a partnership with the
United States to improve military hospitals.
Minister of State for Defence Roland Oritsejafor said the "HIV/AIDS
pandemic was a devastating scourge that affected every facet of national
life," according to a statement of comments from a visit he paid to a
Nigerian air force hospital.
Oritsejafor said that Nigeria launched its Armed Forces Programme on
HIV/AIDS in 1991 due to the security threat posed by the virus.
Oritsejafor lauded his ministry's partnership with the US Department of
Defence that has seen the refurbishment and upgrading of four military
medical facilities in different parts of Nigeria.
A joint emergency plan for 2006 has begun free anti-retroviral therapy in
several military hospitals, including free testing and treatment for
military officials, their families and civilians in military barracks and
nearby communities, the statement said.
The African country was due this month to begin dispensing free
anti-retroviral (ARV) drugs to HIV/AIDS patients, according to an earlier
government statement.
Nigeria has the world's third highest population of people with HIV/AIDS,
after India and South Africa, with more than 3.5 million people infected
with the virus.
An HIV-positive man has been arrested in India's western state of Gujarat
after his wife accused him of concealing his disease for over four years,
police said on Wednesday.
Police arrested Harish Kantharia at his home in the city of Surat and
have charged him with committing a "negligent act that could endanger
life."
"I went for a routine gynaecological test during my pregnancy and
medical reports revealed that I am HIV positive," said Kantharia's
second wife, Lata, who then forced her husband to take blood tests.
Police officer R. S. Patel said Kantharia had confessed.
"He admitted that he (knew he) was infected by the deadly virus but
he hid it from the complainant and even from his first wife who died due to
AIDS."
Lata, who married Kantharia in May 2002, plans to seek compensation for
herself and her unborn child.
AIDS workers praised her defiance.
"This is a rare case as Indian women, who are mostly infected by
their husbands, never muster the courage to file a criminal complaint
despite the fact that they are cheated by their husbands," said Dr.
Anil Dhaval of the Gujarat HIV+ Society.
India is second only to South Africa in the size of its HIV-positive
population, with officially more than 5.1 million people living with
HIV/AIDS.
Half of them are women often infected by husbands who visit sex workers.
Non-government organisations say true infection rates are much higher.
|
01 Feb 2006 12:17:19 GMT
Source: IRIN
|
GABORONE, 1 February (IRIN) - Botswana's decision to introduce routine HIV
testing in all its health facilities was driven by the growing realisation that
plans to provide anti-AIDS medication were likely to fail unless more people
were tested.
But activists have expressed concern that the policy could be eroding the
patient's right to confidentiality, with the risk of informed consent being
compromised.
The landlocked Southern African country has all the ingredients for turning
the epidemic around: political leadership, optimal use of existing resources and
an established treatment plan. But fear of stigma has proved an even bigger
hurdle, causing people to wait until they are very ill before seeking treatment.
Two years down the line, health officials estimate that up to 35 percent of
the 1.7 million Batswana now know their status.
At Princess Marina hospital in the capital, Gaborone, acting hospital
superintendent Dr Howard Moffat told IRIN that although routine testing was
yielding results, implementing it had not been easy.
As the only referral hospital in the south of the country, long queues and
overworked staff were nothing new at Princess Marina, but throwing the new
testing strategy into the mix had been time-consuming, he observed.
"We have to keep record of each patient, and it is so difficult because
we have to attend to a lot of patients ... [as with] any other ailment, we tell
the patients of the test that we will administer, and if they are not ready they
can refuse but generally patients agree to be tested," Moffat said.
AIDS activists like Christine Stegling, director of the Botswana Network of
Law and Ethics (BONELA), are not convinced. She has called on the government to
adopt stricter measures for monitoring the testing strategy.
Soon after the programme began, BONELA called a meeting with relevant
stakeholders to debate the implementation of routine testing in Botswana. Their
concern was that the government had failed to launch a public information
campaign and BONELA claimed to have received complaints from patients who said
they were not thoroughly informed, while others said they were unaware that they
had been tested until they received the results.
An equally sceptical David Ngele, one of the first Batswana to publicly
disclose his HIV-positive status, said he had doubts about "the quality of
counselling offered by some people who carry out routine testing", but
acknowledged the "normalising" effect it was having, as many more
people had been tested since the policy was introduced.
"This is quite helpful, as people test in time [and] therefore receive
necessary help before their condition worsens," he pointed out.
Stegling argued that while it was important for people to know their status,
they should have the right not to be tested if they felt they were not ready.
According to her, most Batswana have a tendency to obey nurses and doctors
without question.
"We at BONELA feel that people should be taught, so that they know that
they have the right to refuse if they do not want to be tested, and that they
should be equipped with the relevant information to help them make informed
choices," Stegling maintained.
Although Bakang Kgwaane, a builder, was not given much information before his
test, he admitted that he had benefited from discovering he was HIV-positive. He
fell ill with a persistent cough, swollen feet and weight loss in 2001 and was
forced to leave his job. After being admitted to the Bamalete Lutheran Hospital
he was treated for TB and advised to be tested for the HI virus.
"I was in great pain - my sister was called for discussions. She
consented and because I was in pain I just gave in," he said. When the
results came back positive, Kgwaane said he felt his whole world was collapsing.
"To be honest with you, I was not really prepared to get my results, but
they were there and I had no choice."
|
01 Feb 2006 08:57:06 GMT
Source: IRIN
|
STONE TOWN, ZANZIBAR, 1 February (IRIN) - Campaigns to fight HIV/AIDS often
focus on the "ABC" strategy - or Abstinence, Be faithful and use
Condoms. However, on the ultra-conservative, predominantly Muslim island of
Zanzibar, the condom remains taboo and is rarely incorporated into public
awareness messages.
"We believe that advocating the use of condoms is promoting illegal sex,
mainly among the youth," said Fadhil Soraga, secretary at the office of
Zanzibar's mufti, or senior Muslim scholar. "The proper campaign is A and
B."
While public talks or advertising campaigns about HIV/AIDS in Zanzibar may
advise people to "Abstain, Be faithful," these messages carefully omit
condom use as way to prevent HIV/AIDS.
"We are always loud when mentioning the letters A and B, but we mumble
when it comes to the C," said HIV/AIDS activist Asha Hussein.
In 2003, a United Nations-supported government survey on the main islands of
Unguja and Pemba found HIV/AIDS prevalence in the general population to be 0.6
percent. While the rate is relatively low compared to prevalence rates in the
region - mainland Tanzania, for example, has an HIV/AIDS prevalence of 7 percent
- health officials nevertheless estimate that the rate is rising.
Ameir Khamis, a government epidemiology and surveillance coordinator,
estimated that about 8,000 Zanzibaris were currently living with HIV/AIDS, up
from 6,000 in 2002.
Officials from Medicos Del Mundo (MDM), an international NGO working on
HIV/AIDS in Zanzibar, said they had to be careful in their campaign against the
pandemic.
"We're using many ways to deliver the message to stop the spread of AIDS
and other sexually transmitted diseases, but speaking about condoms in Zanzibar
society is still very difficult," said Erene Casas, MDM project coordinator
in Zanzibar.
The European Union-supported MDM has been working to prevent the spread of
HIV/AIDS, mother-to-child transmission of HIV/AIDS and sexually transmitted
infections in Zanzibar since April 2002. It also organises activities to
sensitise the population, especially young people, on safer sex.
A moral issue
"Community leaders - including religious and civic leaders - are not
ready for the condom-use theory," Khamis said.
A poster by the Zanzibar AIDS Commission in Stone Town, the island's main
town, reads: "Our culture is the best cure for HIV/AIDS. Observe our
culture and religion to stop the spread of the disease."
Soraga, from the mufti's office, blamed the rise in the prevalence of
HIV/AIDS on the degeneration of morality on the island.
"Despite repeated religious calls and the many seminars on HIV/AIDS in
Zanzibar, the number of HIV cases has been increasing because people do not want
to change their behaviour," he said. "We must reform our behaviour,
mainly by refraining from illegal sex."
Although the government and religious institutions are reluctant to promote
condoms, their use is on the rise - albeit silently - mainly among youths.
Ramadhani Hassan, MDM's local coordinator, confirmed that condom
"consumption" had increased. "During the film and traditional
festivals in June and July, we distributed more than 90,000 condoms free of
charge," he said.
"The statistics show that although it is illicit to talk about condoms
in Zanzibar society, their utilisation has been increasing," he added.
Stigma and discrimination
Stigma and discrimination were barriers to the prevention, treatment and care
of HIV/AIDS patients in Zanzibar, Casas said. Many people living with the virus
were reluctant to disclose their status, even when their employers encouraged
them to seek out testing and counselling services.
"These barriers are internalised so that people do not seek diagnostic
or treatment services, or the means to protect themselves," she said.
"The main causes of stigma involve incomplete knowledge, fear of death
and disease, sexual norms, and lack of recognition of stigma," she said.
The Zanzibar Association of People with HIV/AIDS reported that HIV-positive
people on the island faced physical and social isolation from family, friends
and the community. Discrimination often extended to the workplace as well and
hampered access to government services.
The inability of women to negotiate condom use has also proved to be a
barrier to preventing the spread of the virus.
Hassan noted that a lack of confidence prevented many women from demanding
that their partners use condoms, placing them at great risk. A 2003 government
study showed that infection rates among women were three times higher than men.
Casas said stigma limited the circulation of information about the epidemic
and options for care, as well as communication within couples about the risks of
contracting HIV/AIDS.
"I think we need to do everything possible to prevent the spread of
HIV/AIDS," she said.
Impoverished
AIDS patients in
East China
's
Anhui
Province
will be housed in government-funded residences, according to
local government sources.
The province
has vowed to step up efforts to prevent the spread of HIV/AIDS and to offer more
care to the victims. It has pledged to arrange housing for needy AIDS patients
and to provide drinking water facilities for HIV/AIDS families.
In addition,
the provincial government has promised to build at least one road in key
HIV/AIDS-stricken villages and to ensure adequate medical care and living
subsidies for HIV/AIDS infected people.
(Source: Xinhua)
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